Identifying subgroups of U.S. adults at risk for prolonged television viewing to inform program development

Engagement With Remote Delivery Channels in a Physical Activity Intervention for Senior Women in the US

PURPOSE

Identify the effects of engagement with different intervention delivery channels on physical activity (PA), and the participant subgroups engaging with the different channels, among Women's Health Initiative Strong and Healthy (WHISH) PA trial participants.

DESIGN

Secondary analysis of data from WHISH, a pragmatic trial that used passive randomized consent.

SETTING

United States (remote intervention in all 50 states).

SAMPLE

18,080 U.S. women, aged 68-99 years, assigned to the WHISH PA intervention arm.

MEASURES

6 dichotomous variables operationalized engagement: Engagement with Targeted Inserts, Email (opened), Email (clicked links), Website (logging in), Website (tracking), Interactive Voice Response (IVR). PA was measured using the CHAMPS PA questionnaire.

ANALYSIS

Linear regressions evaluated effects of engagement on PA. Conditional Inference Trees identified subgroups of participants engaging with different channels based on demographic and psychosocial variables.

RESULTS

Engagement with each channel, except IVR, was associated with significantly more hours/week of PA (square root coefficients .29 - .13, P values <.001). Consistently across channels, features that identified subgroups of participants with higher engagement included younger age, and higher levels of PA and physical function. Subgroups with the highest engagement differed from those with the lowest in most participant characteristics.

CONCLUSIONS

For equitable population-level impact via large-scale remotely-delivered PA programs, it may be necessary to identify strategies to engage and target harder to reach subgroups more precisely.

CLINICAL TRIAL REGISTRATION

The WHISH trial is registered at ClinicalTrials.gov (No. NCT02425345).

Relationship between Sociodemographic and Health-Related Factors and Sedentary Time in Middle-Aged and Older Adults in Taiwan

Background and Objectives: This study aimed to investigate the associations between sociodemographic and health-related factors and sedentary time in middle-aged and older Taiwanese adults. Materials and Methods: A total of 1031 participants (460 men, 571 women; mean age 65.0 years ± 7.8 years; range 55 to 93 years) were randomly recruited from the National Computer Assessment Telephone Interview, Taiwan, in 2013. Sedentary time, TV viewing, physical activity, and sociodemographic factors were assessed through questionnaires. Body mass index was self-reported and calculated to evaluate obesity. In 2023, the associations between sedentary time and sociodemographic and health-related factors were analyzed using Pearson's correlation, cross tabulation, and logistic regression and were stratified by gender. Results: Over 47% of participants reported spending more than 2 h watching TV, and more than 33% reported engaging in over 6 h of total sedentary activities. Men and women with insufficient physical activity had a higher probability of prolonged sedentary time than their physically active counterparts (p = 0.032 for men, p = 0.024 for women). Both men and women who spent more than 2 h watching TV daily were more likely to have high sedentary time compared to those with shorter TV viewing durations (both p < 0.001). Highly educated and unmarried women exhibited a higher likelihood of prolonged sedentary time than their less educated and married counterparts (p = 0.021 and p = 0.01, respectively). Conclusions: Sedentary time showed significant and positive associations with both insufficient physical activity and prolonged TV viewing in both genders. Additionally, significant associations were observed between sedentary time and high education and unmarried status in women. These findings emphasize the importance of implementing gender-specific approaches in future interventions and policy initiatives aimed at reducing sedentary behavior among middle-aged and older adults.

A longitudinal exploration of self-reported TV behaviours as a surrogate for sedentary behaviour in older adults with an intellectual disability from the intellectual disability supplement to the Irish longitudinal study on aging (IDS-TILDA) study

This study presents the findings of an investigation into the self-reported TV habits of adults with an intellectual disability, where time watching TV was used as a proxy for sedentary behaviour (SB). Risk factors identified for the general and intellectual disability populations and standard covariates of age, sex, level of intellectual disability, living circumstances and BMI were explored to determine their viability as contributors to increased TV viewing and SB. Missing data was imputed using Multiple Imputation Chained Equation (MICE). Multinomial logistic regression and Chi-squared Automatic Interaction Detector Analysis (CHAID) analyses of risk factors for increased TV viewing were explored and compared. The Systems of Sedentary Behaviour (SOS) framework was used to structure results. Novel risk factors for increased TV viewing were identified.

Relationship between physical activity, sedentarism and obesity in adults, Colombia, 2015

Introduction. Physical inactivity and sedentary behaviors were shown to be risk factors in the prevalence of diseases such as obesity. Objective. To conduct an analysis of the relationship between physical activity, sedentary lifestyle and nutritional status in the population aged 18 to 64 years in Colombia, 2015. Materials and methods. A secondary analysis of the 2015 Colombian nutrition survey was done, using sociodemographic variables (age, sex, ethnicity, geographic area, region, wealth index), along with weight, height, physical activity and sedentary lifestyle. Proportions and 95% confidence intervals, chi-square, logistic regression and odds ratio were estimated. Results. The analyzed population included 16,607 individuals (54.8% women and 45.2% men) aged 18 to 64 years. Men were more overweight (37.6%) than women, while obesity was more frequent in women (22.1%). It was observed that 48.3% did not meet the physical activity recommendations; 56.9% of adults spent two or more hours a day watching screens. There was a significant association (p<0.050) between non-compliance with physical activity recommendations and obesity. In addition, complying with the physical activity recommendation decreases the probability of obesity by 1.25 times. Conclusion. Obesity is a health problem for the adult population, with a higher prevalence in women and in those over 30 years old. It is related to non-compliance with the recommendations about physical activity and sedentary behaviors (which are more prevalent in Afro-descendants), high wealth quartile status, and to reside in urban areas and to live in the Bogotá area.

Sociodemographic, Behavioural, and Health Factors Associated with Sedentary Behaviour in Community-Dwelling Older Adults: A Nationwide Cross-Sectional Study

Few studies have focused on factors associated with sedentary behaviour among older Asian adults. This study aimed to identify factors independently associated with prolonged sedentary times in Korean older adults. We included 8273 community-dwelling older adults aged ≥65 years who participated in the Korean National Health and Nutrition Examination Survey. Self-reported sedentary times were assessed via the Global Physical Activity Questionnaire, and sedentary times of ≥420 min/day were considered 'long'. Complex-sample multivariable-adjusted logistic regression analyses were conducted to investigate the factors associated with long sedentary times. Among the participants, 4610 (55.72%) had long sedentary times that were associated with advanced age (odds ratio [OR], 2.49; 95% confidence interval [CI], 2.05-3.01), female sex (OR, 1.32; 95% CI, 1.11-1.57), unemployment (OR, 1.23; 95% CI, 1.09-1.38), living alone (OR, 1.24; 95% CI, 1.08-1.43), urban residence (OR, 1.35; 95% CI, 1.14-1.61), and insufficient aerobic exercise (OR, 1.80; 95% CI, 1.60-2.02). Among health factors, obesity (OR, 1.27; 95% CI, 1.12-1.45), diabetes (OR, 1.17; 95% CI, 1.04-1.32), cardiovascular diseases (OR, 1.30; 95% CI, 1.11-1.52), and arthritis (OR, 1.26; 95% CI, 1.11-1.43) had positive associations with long sedentary times. A tailored approach that considered various sociodemographic, behavioural, and health factors is needed to reduce sedentary behaviour in this population.

Sedentary Behavior Patterns of the Hungarian Adult Population

BACKGROUND AND AIM

Nowadays, a high level of sedentary behavior (SB) is an important health issue. Many studies have focused on evaluating the physical activity (PA) level, while evaluation of SB has received less attention. The main goal of the present study is to describe the sedentary lifestyle of the Hungarian adult population and identify the vulnerable groups with high amount of sitting time and the patterns of SB. Another aim of this study is to compare the two types of questionnaires (International Physical Activity Questionnaire-IPAQ and Sedentary Behavior Questionnaire-SBQ) related to sitting time.

METHODS

This study analyzed cross-sectional primary data using self-reported questionnaires collected by a Hungarian research market company among the adult population in Hungary. The final sample of this study consisted of 1295 participants with a mean age of 45.9 years (SD = 15.2). Analysis of variance (ANOVA) test with post-hoc (Tukey) analysis were used to analyze the link between sitting time and socio-demographic variables (sex, age, BMI, settlement type, education level, marital status, work category, working hours, employment status, sport activity) and body mass index (BMI).

RESULTS AND CONCLUSIONS

According to the SBQ, on average, Hungarians sit for 469.53 min per day (7.81 h) on weekdays and 421.25 min per day (7.01 h) on weekends, which suggested a significant difference compared to IPAQ data: 287.82 min per day (4.79 h) on weekdays and 224.30 min per day (3.73 h) on weekends. Young people (aged between 18 and 29) were reported to have the highest average sitting time, i.e., 545 min per day (more than 9 h), and are showing the highest prevalence (53%) of sitting at least 480 min (8 h) per day. Sitting workers also had a high average sitting time, i.e., 514.82 min per day, and a high prevalence (49.3%) of sitting at least 480 min (8 h) per day. People who live in the capital city had higher sitting time, especially on working days. Men sat longer than woman, i.e., 19 min on working days and 45 min on weekends. The most frequent sedentary activities are: working on computer (126 min) on working days and watching TV (130 min) on weekends. Our results clearly show that the self-report single-item measure (IPAQ) significantly underestimates sedentary time compared to the multi-item questionnaire (SBQ). We identified vulnerable groups with high sitting times: men, young adults, inhabitants of the capital city and sitting workers. Consequently, these groups should be continuously surveyed, and requires specific interventions and strategies that particularly counteract the increased sitting time.

Patterns and Predictors of Television Viewing and Computer Use Among Women Living in Socioeconomically Disadvantaged Neighborhoods: A Prospective Cohort Study

BACKGROUND

Socioeconomically disadvantaged women are at an increased risk of sedentary behaviors including television (TV) viewing and computer use, so identifying determinants of these behaviors is important.

METHODS

Women (n = 4349) self-reported weekly TV and computer time (in minutes per week), sociodemographic, and health data at 3 time points (2007-2013). Mixed-effect negative binomial regression was used to determine the baseline determinants of TV viewing and computer use over time, adjusting for confounders.

RESULTS

Over 5 years, median TV viewing decreased while median computer time increased. Cross-sectionally TV viewing was highest among participants classified as obese, with poorer health, current smokers, with lower education, not working, with no income, without partners and with no children and computer time was greater among younger women, living in urban areas, working full time, with higher education, without partners and with no children. Average computer time per year increased among those not working (7%), with lower education (5%), and with children (5%) but decreased among those with higher education (1%). However, no factors were associated with a change in TV viewing over time.

CONCLUSION

Among socioeconomically disadvantaged women, interventions aimed at preventing increases in computer time should consider women with lower education, not working, and with children in their design.

A comparison of total and domain-specific sedentary time in breast cancer survivors and age-matched healthy controls

Breast cancer survivors (BCS) engage in more sedentary behavior (SED) than those without cancer. However, the context in which SED is accrued is unknown. The purpose of this study is to examine differences in total and domain-specific SED of BCS and healthy controls. 20 BCS and 20 age-matched, healthy controls wore ActiGraph GT3X + accelerometers to measure SED and activity. Participants self-reported SED for transportation, occupational, screen time and leisure purposes. Multiple linear regressions were used to estimate differences in SED between BCS and controls. BCS spent significantly more time watching TV (152.4 vs. 60.3; p < 0.01) and less time in total SED (490.8 vs. 587.4; p = 0.046) and other leisure activities (57.6 vs. 106.9; p < 0.01) than healthy controls. BCS engage in more TV watching and less time in other leisure activities than controls, thus interventions should focus on reducing TV time. Understanding facilitators of TV viewing is needed to determine specific intervention targets.

The Influence of Neighborhood Social Capital on Leisure-Time Physical Activity: a Population-Based Study in Brazil

Environmentally targeted approaches to promote physical activity are emerging in recent years as a complementary strategy to the traditional individual approaches. This study explored the relation between community social capital and leisure-time physical activity in an adult population-based sample in Brazil. We applied a generalized estimating equation approach to analyze a cross-sectional survey of 3667 adults living in 149 neighborhoods. Social capital was assessed by scales that measured collective efficacy and social cohesion in the neighborhood. We find that individuals living in areas with higher level of social cohesion were more likely to be physically active even after controlling for potentially confounding individual and area-level covariates (PR = 1.56; 95% CI = 1.13, 2.16). Collective efficacy was not significantly associated with leisure-time physical activity. Interventions to strengthen social cohesion in the community may be an avenue for promoting physical activity.

Screen-Related Parenting Practices in Low-Income Mexican American Families

OBJECTIVES

To (1) examine whether the Information-Motivation-Behavioral Skills Model predicts maternal screen-related parenting practices and (2) evaluate the relationship of American Academy of Pediatrics (AAP)-recommended parenting practices with child television (TV) use behaviors.

METHODS

In this cross-sectional study, 312 Spanish-speaking and/or English-speaking female primary caregivers of Mexican descent with a child 3 to 5 years of age were recruited from safety-net pediatric clinics. Participants completed a phone interview and screen media diary. Measures included maternal screen-related beliefs, self-efficacy, parenting practices (time restriction, TV in the child's bedroom, allowing viewing while eating meals and while eating snacks), and child viewing behaviors (amount of TV viewing, frequency of eating while viewing). Two path analytic models were estimated.

RESULTS

Positive general beliefs about TV viewing and positive functional beliefs were negatively associated with maternal self-efficacy to restrict TV time (β = -0.14, P < .05; β = -0.27, P < .001). Greater self-efficacy to restrict time was associated with more maternal restriction of time (β = 0.29, P < .001). Greater positive functional beliefs were associated with less self-efficacy to restrict TV viewing with snacks (odds ratio = 0.56; 95% confidence interval, 0.38-0.81). High self-efficacy to restrict viewing with snacks was associated with less allowing of viewing while snacking (β = -0.16, P < .01). Time restriction, TV in the child's bedroom, and allowing viewing while snacking were associated with child TV viewing behaviors.

CONCLUSIONS

Providers should consider maternal beliefs, including beliefs regarding the functional use of screens, and self-efficacy to engage in AAP-recommended parenting practices, when counseling on screen use in this population.

Patterns of sedentary behavior in overweight and moderately obese users of the Catalan primary-health care system

Background and objectives

Prolonged sitting time (ST) has negative consequences on health. Changing this behavior is paramount in overweight/obese individuals because they are more sedentary than those with normal weight. The aim of the study was to establish the pattern of sedentary behavior and its relationship to health, socio-demographics, occupation, and education level in Catalan overweight/obese individuals.

Methods

A descriptive study was performed at 25 healthcare centers in Catalonia (Spain) with 464 overweight/moderately obese patients, aged25 to 65 years. Exclusion criteria were chronic diseases which contraindicated physical activity and language barriers. Face-to-face interviews were conducted to collect data on age, gender, educational level, social class, and marital status. Main outcome was ‘sitting time’ (collected by the Marshall questionnaire); chronic diseases and anthropometric measurements were registered.

Results

464 patients, 58.4% women, mean age 51.9 years (SD 10.1), 76.1% married, 60% manual workers, and 48.7% had finished secondary education. Daily sitting time was 6.2 hours on working days (374 minutes/day, SD: 190), and about 6 hours on non-working ones (357 minutes/day, SD: 170). 50% of participants were sedentary ≥6 hours. The most frequent sedentary activities were: working/academic activities around 2 hours (128 minutes, SD: 183), followed by watching television, computer use, and commuting. Men sat longer than women (64 minutes more on working days and 54 minutes on non-working days), and individuals with office jobs (91 minutes),those with higher levels of education (42 minutes), and younger subjects (25 to 35 years) spent more time sitting.

Conclusions

In our study performed in overweight/moderately obese patients the mean sitting time was around 6 hours which was mainly spent doing work/academic activities and watching television. Men, office workers, individuals with higher education, and younger subjects had longer sitting time. Our results may help design interventions targeted at these sedentary patients to decrease sitting time.

Correlates of sedentary behaviour in adults: a systematic review

OBJECTIVE

The objective of this study was to systematically review evidence to identify intrapersonal, social environmental, physical environmental and policy correlates of sedentary behaviour (SB) among adults.

METHODS

Six databases were searched to identify studies that reported on intrapersonal, social, physical environmental and/or policy correlates of SB across domains (i.e. occupational, leisure and transportation) in adults (mean ≥ 18 years old). Subgroup differences (sex, age, disease status, publication status and date, weekdays vs. weekend) were examined. Risk of bias was assessed, and a qualitative synthesis completed.

PROSPERO

CRD42014009814 RESULTS: Searching identified 22,779 articles; 257 were used in the analysis. Most studies used self-reported SB and were cross-sectional. The most studied domain of SB and correlate was leisure and intrapersonal, respectively. Consistent evidence found positive relationships between full-time employment and higher transportation and lower leisure SB; higher income/socioeconomic status and greater transportation and occupation SB; living in more urban areas and greater sitting time and total SB; ownership of televisions and greater leisure SB; and, active workstations and lower occupational SB.

CONCLUSIONS

The review identifies the need for longitudinal studies, as well as further research on factors in the physical, social and policy environments. The review also recognizes the need to standardize methodology for collecting, defining and reporting SB and correlates.

Characterizing user engagement with health app data: a data mining approach

The use of mobile health applications (apps) especially in the area of lifestyle behaviors has increased, thus providing unprecedented opportunities to develop health programs that can engage people in real-time and in the real-world. Yet, relatively little is known about which factors relate to the engagement of commercially available apps for health behaviors. This exploratory study examined behavioral engagement with a weight loss app, Lose It! and characterized higher versus lower engaged groups. Cross-sectional, anonymized data from Lose It! were analyzed (n = 12,427,196). This dataset was randomly split into 24 subsamples and three were used for this study (total n = 1,011,008). Classification and regression tree methods were used to identify subgroups of user engagement with one subsample, and descriptive analyses were conducted to examine other group characteristics associated with engagement. Data mining validation methods were conducted with two separate subsamples. On average, users engaged with the app for 29 days. Six unique subgroups were identified, and engagement for each subgroup varied, ranging from 3.5 to 172 days. Highly engaged subgroups were primarily distinguished by the customization of diet and exercise. Those less engaged were distinguished by weigh-ins and the customization of diet. Results were replicated in further analyses. Commercially-developed apps can reach large segments of the population, and data from these apps can provide insights into important app features that may aid in user engagement. Getting users to engage with a mobile health app is critical to the success of apps and interventions that are focused on health behavior change.

Which psychological, social and physical environmental characteristics predict changes in physical activity and sedentary behaviors during early retirement? A longitudinal study

BACKGROUND

In the context of healthy ageing, it is necessary to identify opportunities to implement health interventions in order to develop an active lifestyle with sufficient physical activity and limited sedentary time in middle-aged and older adults. The transition to retirement is such an opportunity, as individuals tend to establish new routines at the start of retirement. Before health interventions can be developed, the psychological, social and physical environmental determinants of physical activity and sedentary behaviors during early retirement should be identified, ideally with longitudinal studies. The aim of this paper was first to examine whether psychological, social and physical environmental factors at the start of retirement predict longitudinal changes in physical activity and sedentary behaviors during the first years of retirement. Second, moderating effects of gender and educational levels were examined.

METHODS

This longitudinal study was conducted in Flanders, Belgium. In total, 180 recently retired (>1 month, <2 years at baseline) adults completed a postal questionnaire twice (in 2012-2013 and two years later in 2014-2015). The validated questionnaire assessed socio-demographic information, physical activity, sedentary behaviors, and psychological, social and physical environmental characteristics. Multiple moderated hierarchic regression analyses were conducted in SPSS 22.0.

RESULTS

Higher perceived residential density (p < 0.001) and lower aesthetics (p = 0.08) predicted an increase in active transportation (adjusted R² = 0.18). Higher baseline self-efficacy was associated with an increase in leisure-time physical activity (p = 0.001, adjusted R² = 0.13). A more positive perception of old age (p = 0.04) and perceiving less street connectivity (p = 0.001) were associated with an increase in screen time (adjusted R² = 0.06). Finally, higher baseline levels of modeling from friends (p = 0.06) and lower perceived land use mix access (p = 0.09) predicted an increase in car use (adjusted R² = 0.06). A few moderating effects, mainly of educational level, were found.

DISCUSSION

Walkability characteristics (perceived residential density) and self-efficacy at the start of retirement are the most important predictors of longitudinal changes in active transportation and leisure-time physical activity. Few moderating effects were found, so health interventions at the start of retirement focusing on self-efficacy and specific walkability characteristics could be effective to increase physical activity in recently retired adults. No firm conclusions can be drawn on the importance of the examined predictors to explain change in car use and screen time, possibly other factors like the home environment, or automatic processes and habit strength are more important to explain sedentary behaviors.

Social correlates of leisure-time sedentary behaviours in Canadian adults

Research on the correlates of sedentary behaviour among adults is needed to design health interventions to modify this behaviour. This study explored the associations of social correlates with leisure-time sedentary behaviour of Canadian adults, and whether these associations differ between different types of sedentary behaviour. A sample of 12,021 Canadian adults was drawn from the 2012 Canadian Community Health Survey, and analyzed using binary logistic regression to model the relationships that marital status, the presence of children in the household, and social support have with overall time spent sitting, using a computer, playing video games, watching television, and reading during leisure time. Covariates included gender, age, education, income, employment status, perceived health, physical activity level, body mass index (BMI), and province or territory of residence. Extensive computer time was primarily negatively related to being in a common law relationship, and primarily positively related to being single/never married. Being single/never married was positively associated with extensive sitting time in men only. Having children under 12 in the household was protective against extensive video game and reading times. Increasing social support was negatively associated with extensive computer time in men and women, while among men increasing social support was positively associated with extensive sitting time. Computer, video game, television, and reading time have unique correlates among Canadian adults. Marital status, the presence of children in the household, and social support should be considered in future analyses of sedentary activities in adults.

Lifestyle correlates of overweight in adults: a hierarchical approach (the SPOTLIGHT project)

BACKGROUND

Obesity-related lifestyle behaviors usually co-exist but few studies have examined their simultaneous relation with body weight. This study aimed to identify the hierarchy of lifestyle-related behaviors associated with being overweight in adults, and to examine subgroups so identified.

METHODS

Data were obtained from a cross-sectional survey conducted across 60 urban neighborhoods in 5 European urban regions between February and September 2014. Data on socio-demographics, physical activity, sedentary behaviors, eating habits, smoking, alcohol consumption, and sleep duration were collected by questionnaire. Participants also reported their weight and height. A recursive partitioning tree approach (CART) was applied to identify both main correlates of overweight and lifestyle subgroups.

RESULTS

In 5295 adults, mean (SD) body mass index (BMI) was 25.2 (4.5) kg/m2, and 46.0 % were overweight (BMI ≥25 kg/m2). CART analysis showed that among all lifestyle-related behaviors examined, the first identified correlate was sitting time while watching television, followed by smoking status. Different combinations of lifestyle-related behaviors (prolonged daily television viewing, former smoking, short sleep, lower vegetable consumption, and lower physical activity) were associated with a higher likelihood of being overweight, revealing 10 subgroups. Members of four subgroups with overweight prevalence >50 % were mainly males, older adults, with lower education, and living in greener neighborhoods with low residential density.

CONCLUSION

Sedentary behavior while watching television was identified as the most important correlate of being overweight. Delineating the hierarchy of correlates provides a better understanding of lifestyle-related behavior combinations which may assist in targeting preventative strategies aimed at tackling obesity.

Sedentary Behavior and Cardiovascular Morbidity and Mortality: A Science Advisory From the American Heart Association

Epidemiological evidence is accumulating that indicates greater time spent in sedentary behavior is associated with all-cause and cardiovascular morbidity and mortality in adults such that some countries have disseminated broad guidelines that recommend minimizing sedentary behaviors. Research examining the possible deleterious consequences of excess sedentary behavior is rapidly evolving, with the epidemiology-based literature ahead of potential biological mechanisms that might explain the observed associations. This American Heart Association science advisory reviews the current evidence on sedentary behavior in terms of assessment methods, population prevalence, determinants, associations with cardiovascular disease incidence and mortality, potential underlying mechanisms, and interventions. Recommendations for future research on this emerging cardiovascular health topic are included. Further evidence is required to better inform public health interventions and future quantitative guidelines on sedentary behavior and cardiovascular health outcomes.

Investigating the influence of eating habits, body weight and television programme preferences on television viewing time and domestic computer usage

Background:

The present study explored the influence of eating habits, body weight and television programme preference on television viewing time and domestic computer usage, after adjusting for sociodemographic characteristics and home media environment indicators. In addition, potential substitution or complementarity in screen time was investigated.

Methods:

Individual level data were collected via questionnaires that were administered to a random sample of 2,946 Germans. The econometric analysis employed a seemingly unrelated bivariate ordered probit model to conjointly estimate television viewing time and time engaged in domestic computer usage.

Results:

Television viewing and domestic computer usage represent two independent behaviours in both genders and across all age groups. Dietary habits have a significant impact on television watching with less healthy food choices associated with increasing television viewing time. Body weight is found to be positively correlated with television screen time in both men and women, and overweight individuals have a higher propensity for heavy television viewing. Similar results were obtained for age groups where an increasing body mass index (BMI) in adults over 24 years old is more likely to be positively associated with a higher duration of television watching. With respect to dietary habits of domestic computer users, participants aged over 24 years of both genders seem to adopt more healthy dietary patterns. A downward trend in the BMI of domestic computer users was observed in women and adults aged 25–60 years. On the contrary, young domestic computer users 18–24 years old have a higher body weight than non-users. Television programme preferences also affect television screen time with clear differences to be observed between genders and across different age groups.

Conclusions:

In order to reduce total screen time, health interventions should target different types of screen viewing audiences separately.

Effects of Three Motivationally Targeted Mobile Device Applications on Initial Physical Activity and Sedentary Behavior Change in Midlife and Older Adults: A Randomized Trial

BACKGROUND

While there has been an explosion of mobile device applications (apps) promoting healthful behaviors, including physical activity and sedentary patterns, surprisingly few have been based explicitly on strategies drawn from behavioral theory and evidence.

OBJECTIVE

This study provided an initial 8-week evaluation of three different customized physical activity-sedentary behavior apps drawn from conceptually distinct motivational frames in comparison with a commercially available control app.

STUDY DESIGN AND METHODS

Ninety-five underactive adults ages 45 years and older with no prior smartphone experience were randomized to use an analytically framed app, a socially framed app, an affectively framed app, or a diet-tracker control app. Daily physical activity and sedentary behavior were measured using the smartphone's built-in accelerometer and daily self-report measures.

RESULTS

Mixed-effects models indicated that, over the 8-week period, the social app users showed significantly greater overall increases in weekly accelerometry-derived moderate to vigorous physical activity relative to the other three arms (P values for between-arm differences = .04-.005; Social vs. Control app: d = 1.05, CI = 0.44,1.67; Social vs. Affect app: d = 0.89, CI = 0.27,1.51; Social vs. Analytic app: d = 0.89, CI = 0.27,1.51), while more variable responses were observed among users of the other two motivationally framed apps. Social app users also had significantly lower overall amounts of accelerometry-derived sedentary behavior relative to the other three arms (P values for between-arm differences = .02-.001; Social vs. Control app: d = 1.10,CI = 0.48,1.72; Social vs. Affect app: d = 0.94, CI = 0.32,1.56; Social vs. Analytic app: d = 1.24, CI = 0.59,1.89). Additionally, Social and Affect app users reported lower overall sitting time compared to the other two arms (P values for between-arm differences < .001; Social vs. Control app: d = 1.59,CI = 0.92, 2.25; Social vs. Analytic app: d = 1.89,CI = 1.17, 2.61; Affect vs. Control app: d = 1.19,CI = 0.56, 1.81; Affect vs. Analytic app: d = 1.41,CI = 0.74, 2.07).

CONCLUSION

The results provide initial support for the use of a smartphone-delivered social frame in the early induction of both physical activity and sedentary behavior changes. The information obtained also sets the stage for further investigation of subgroups that might particularly benefit from different motivationally framed apps in these two key health promotion areas.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01516411.

Mining Health App Data to Find More and Less Successful Weight Loss Subgroups

Background

More than half of all smartphone app downloads involve weight, diet, and exercise. If successful, these lifestyle apps may have far-reaching effects for disease prevention and health cost-savings, but few researchers have analyzed data from these apps.

Objective

The purposes of this study were to analyze data from a commercial health app (Lose It!) in order to identify successful weight loss subgroups via exploratory analyses and to verify the stability of the results.

Methods

Cross-sectional, de-identified data from Lose It! were analyzed. This dataset (n=12,427,196) was randomly split into 24 subsamples, and this study used 3 subsamples (combined n=972,687). Classification and regression tree methods were used to explore groupings of weight loss with one subsample, with descriptive analyses to examine other group characteristics. Data mining validation methods were conducted with 2 additional subsamples.

Results

In subsample 1, 14.96% of users lost 5% or more of their starting body weight. Classification and regression tree analysis identified 3 distinct subgroups: “the occasional users” had the lowest proportion (4.87%) of individuals who successfully lost weight; “the basic users” had 37.61% weight loss success; and “the power users” achieved the highest percentage of weight loss success at 72.70%. Behavioral factors delineated the subgroups, though app-related behavioral characteristics further distinguished them. Results were replicated in further analyses with separate subsamples.

Conclusions

This study demonstrates that distinct subgroups can be identified in “messy” commercial app data and the identified subgroups can be replicated in independent samples. Behavioral factors and use of custom app features characterized the subgroups. Targeting and tailoring information to particular subgroups could enhance weight loss success. Future studies should replicate data mining analyses to increase methodology rigor.

Neighbourhood urban form and individual-level correlates of leisure-based screen time in Canadian adults

OBJECTIVES

Despite evidence for an association between the built environment and physical activity, less evidence exists regarding relations between the built environment and sedentary behaviour. This study investigated the extent to which objectively assessed and self-reported neighbourhood walkability, in addition to individual-level characteristics, were associated with leisure-based screen time in adults. We hypothesised that leisure-based screen time would be lower among adults residing in objectively assessed and self-reported 'high walkable' versus 'low walkable' neighbourhoods.

SETTING

The study was undertaken in Calgary, Alberta, Canada in 2007/2008.

PARTICIPANTS

A random cross-section of adults who provided complete telephone interview and postal survey data (n=1906) was included. Captured information included leisure-based screen time, moderate-intensity and vigorous-intensity physical activity, perceived neighbourhood walkability, sociodemographic characteristics, self-reported health status, and self-reported height and weight. Based on objectively assessed built characteristics, participant's neighbourhoods were identified as being low, medium or high walkable.

PRIMARY AND SECONDARY OUTCOME MEASURES

Using multiple linear regression, hours of leisure-based screen time per day was regressed on self-reported and objectively assessed walkability adjusting for sociodemographic and health-related covariates.

RESULTS

Compared to others, residing in an objectively assessed high walkable neighbourhood, women, having a college education, at least one child at home, a household income ≥$120 000/year, and a registered motor vehicle at home, reporting very good-to-excellent health and healthy weight, and achieving 60 min/week of vigorous-intensity physical activity were associated (p<0.05) with less leisure-based screen time. Marital status, dog ownership, season, self-reported walkability and achieving 210 min of moderate-intensity physical activity were not significantly associated with leisure-based screen time.

CONCLUSIONS

Improving neighbourhood walkability could decrease leisure-based television and computer screen time. Programmes aimed at reducing sedentary behaviour may want to consider an individual's sociodemographic characteristics, physical activity level, health status and weight status, in addition to the walkability of their neighbourhood as these factors were found to be important independent correlates of leisure-based screen time.

Neighborhood environmental attributes and adults' sedentary behaviors: Review and research agenda

OBJECTIVE

Physical activity recommendations are beginning to address sedentary behaviors - time spent sitting. Environmental and policy initiatives for physical activity might assist in addressing sedentary behaviors, but sedentary-specific innovations may be required. This review synthesizes current evidence on associations of neighborhood environmental attributes with adults' sedentary behaviors.

METHODS

A search was conducted using three electronic databases (PubMed, Web of Science, and Transport Research Information Services). Relevant articles were assessed for their eligibility for inclusion (English-language articles with a quantitative examination of associations of neighborhood environmental attributes with adults' sedentary behaviors).

RESULTS

Within 17 studies meeting inclusion criteria, associations of environmental attributes with sedentary behaviors were examined in 89 instances. Significant associations were found in 28% (n=25) of them; however, non-significant associations were found in 56% (n=50) of these instances. The most consistent association was for lower levels of sedentary behavior among residents of urban compared to regional areas.

CONCLUSIONS

There is a modest but mixed initial evidence in associations of neighborhood environmental attributes with adults' sedentary behaviors. A research agenda required for this emerging field should include the development of more relevant conceptual models, measuring domain-specific sedentary behavior objectively, examining environments in close vicinity of and a larger area around home, and the use of prospective designs.

Prolonged Sitting Time: Barriers, Facilitators and Views on Change among Primary Healthcare Patients Who Are Overweight or Moderately Obese

BACKGROUND AND OBJECTIVES

Prolonged sitting time has negative consequences on health, although the population is not well aware of these harmful effects. We explored opinions expressed by primary care patients diagnosed as overweight or moderately obese concerning their time spent sitting, willingness to change, and barriers, facilitators, goals and expectations related to limiting this behaviour.

METHODS

A descriptive-interpretive qualitative study was carried out at three healthcare centres in Barcelona, Spain, and included 23 patients with overweight or moderate obesity, aged 25 to 65 years, who reported sitting for at least 6 hours a day. Exclusion criteria were inability to sit down or stand up from a chair without help and language barriers that precluded interview participation. Ten in-depth, semi-structured interviews (5 group, 5 individual) were audio recorded from January to July 2012 and transcribed. The interview script included questions about time spent sitting, willingness to change, barriers and facilitators, and the prospect of assistance from primary healthcare professionals. An analysis of thematic content was made using ATLAS.Ti and triangulation of analysts.

RESULTS

The most frequent sedentary activities were computer use, watching television, and motorized journeys. There was a lack of awareness of the amount of time spent sitting and its negative consequences on health. Barriers to reducing sedentary time included work and family routines, lack of time and willpower, age and sociocultural limitations. Facilitators identified were sociocultural change, free time and active work, and family surroundings. Participants recognized the abilities of health professionals to provide help and advice, and reported a preference for patient-centred or group interventions.

CONCLUSIONS

Findings from this study have implications for reducing sedentary behaviour. Patient insights were used to design an intervention to reduce sitting time within the frame of the SEDESTACTIV clinical trial.

Factors associated with higher sitting time in general, chronic disease, and psychologically-distressed, adult populations: findings from the 45 & up study

This study examined factors associated with higher sitting time in general, chronic disease, and psychologically-distressed, adult populations (aged ≥45 years). A series of logistic regression models examined potential socio-demographic and health factors associated with higher sitting (≥6hrs/day) in adults from the 45 and Up Study (n = 227,187), including four separate subsamples for analysis comprising those who had ever had heart disease (n = 26,599), cancer (n = 36,381), diabetes (n = 19,550) or psychological distress (n = 48,334). Odds of higher sitting were significantly (p<.01) associated with a number of factors across these groups, with an effect size of ORs≥1.5 observed for the high-income ≥$70,000AUD, employed full-time and severe physical limitations demographics. Identification of key factors associated with higher sitting time in this population-based sample will assist development of broad-based, public health and targeted strategies to reduce sitting-time. In particular, those categorized as being high-income earners, full-time workers, as well as those with severe physical limitations need to be of priority, as higher sitting appears to be substantial across these groups.

Socio-demographic, clinical and health behavior correlates of sitting time in older adults

BACKGROUND

Identifying correlates of sedentary behavior in older adults is of major importance to healthcare. To our knowledge, there are no population studies in Latin America examining which factors are associated to high sitting time in older adults. Thus, the purpose of this study is to identify socio-demographic, clinical, and health behavior correlates of sitting time in a representative sample of older adults living in Southeastern Brazil.

METHODS

A cross-sectional study was conducted in twenty-four municipalities of the Triangulo Mineiro region in the State of Minas Gerais, Southeastern Brazil. A structured questionnaire was applied to obtain information on socio-demographic, clinical, and health behavior factors. Overall sitting time was assessed using a self-report instrument. A Multiple Correspondence Analysis was used to verify the association of sitting time with socio-demographic, clinical, and health behavior factors.

RESULTS

3,296 older adults (61.5% women and 38.5% men) were included in the analysis. The overall median was 240.0 minutes of sitting time/day. The Multiple Correspondence Analysis showed that the group with the highest sitting time presented the following characteristics: women, age greater than 70 years, unschooled status, arterial hypertension, diabetes mellitus, use of medication, poor self-rated health, dependence in basic activities of daily living, and absence of regular physical activity.

CONCLUSION

This study reveals that socio-demographic, clinical, and health behavior factors are associated with high sitting time in older adults from Southeastern Brazil. The results may help to identify older adults that should be targeted in interventions aiming at reducing sitting time.

Physical activity in young adults: a signal detection analysis of Health Information National Trends Survey (HINTS) 2007 data

Many young adults are insufficiently active to achieve the health benefits of regular physical activity. Using signal detection analysis of data from the 2007 Health Information National Trends Survey, the authors examined distinct subgroups of 18-39 year-old adults who vary in their likelihood of not meeting physical activity recommendations. We randomly split the sample and conducted signal detection analysis on the exploratory half to identify subgroups and interactions among sociodemographic and health communication variables that predicted engaging in less than 150 minutes per week of moderate-intensity physical activity (low physical activity). We compared rates of low physical activity among subgroups with similarly defined subgroups in the validation sample. Overall, 62% of participants did not meet physical activity recommendations. Among 8 subgroups identified, low physical activity rates ranged from 31% to 90%. Predictors of low physical activity were general health, body mass index (BMI), perceived cancer risk, health-related Internet use, and trust in information sources. The least active subgroup (90% low physical activity) included young adults in poor to good health with a BMI of 30.8 or more (obese). The most active subgroup (31% low physical activity) comprised those in very good to excellent health, who used a website to help with diet, weight, or physical activity, and had little to no trust in health information on television. Findings suggest potential intervention communication channels and can inform targeted physical activity interventions for young adults.

Social and physical environmental correlates of adults' weekend sitting time and moderating effects of retirement status and physical health

Emerging research suggests that prolonged sedentary behaviour (SB) is detrimental to health. Changes in SB patterns are likely to occur during particular life stages, for example at retirement age (55–65-year-old). Evidence on socio-ecological SB correlates is scarce and inconsistent in this age group. Moreover, the influence of socio-ecological correlates may vary depending on health and retirement status. This study examined social and environment correlates of overall weekend day sitting among adults at or approaching retirement age, and moderating effects of perceived physical health and retirement status. Baseline data from the Wellbeing, Eating and Exercise for a Long Life study in 2839 Australian adults (55–65-year-old) were analysed. Participants self-reported proximal social factors, neighbourhood social and physical environment, physical health and retirement status. MLwiN multilevel regression analyses were conducted. In the multivariable model, only social support from friends/colleagues to discourage sitting (B = −0.891; p = 0.036) was associated with overall weekend day sitting. No moderation of retirement status, nor physical health were found in the multivariable results. Results from this study suggest the importance of social factors in relation to weekend day sitting among 55–65-year-old adults. Health promotion initiatives in this age group should pay special attention to enhancing social interaction opportunities. Moreover, findings suggest that SB-specific correlates may need to be examined in future research.

Which population groups are most unaware of CVD risks associated with sitting time?

OBJECTIVE

Prolonged sitting is an emerging risk factor for poor health yet few studies have examined awareness of the risks associated with sitting behaviours. This study identifies the population subgroups with the highest levels of unawareness regarding the cardiovascular disease (CVD) risks associated with sitting behaviours.

METHOD

Adults (n=1256) living in Queensland, Australia completed a telephone-based survey in 2011, analysis conducted in 2013. The survey assessed participant's socio-demographic characteristics, physical activity, sitting behaviours and awareness of CVD risks associated with three sitting behaviours: 1) sitting for prolonged periods, 2), sitting for prolonged periods whilst also engaging in regular physical activity, and 3) breaking up periods of prolonged sitting with short activity breaks. Population sub-groups with the highest levels of unawareness were identified based on socio-demographic and behavioural characteristics using signal detection analysis.

RESULTS

Unawareness ranged from 23.3% to 67.0%. Age was the most important variable in differentiating awareness levels; younger adults had higher levels of unawareness. Body mass index, physical activity, TV viewing, employment status and time spent at work also identified population sub-groups.

CONCLUSION

Unawareness of CVD risk for prolonged sitting was moderately high overall. Younger adults had high levels of unawareness on all of the outcomes examined.

Educational inequalities in TV viewing among older adults: a mediation analysis of ecological factors

BACKGROUND

Television (TV) viewing, a prevalent leisure-time sedentary behaviour independently related to negative health outcomes, appears to be higher in less educated and older adults. In order to tackle the social inequalities, evidence is needed about the underlying mechanisms of the association between education and TV viewing. The present purpose was to examine the potential mediating role of personal, social and physical environmental factors in the relationship between education and TV viewing among Australian 55-65 year-old adults.

METHODS

In 2010, self-reported data was collected among 4082 adults (47.6% men) across urban and rural areas of Victoria, for the Wellbeing, Eating and Exercise for a Long Life (WELL) study. The mediating role of personal (body mass index [BMI], quality of life), social (social support from family and friends, social participation at proximal level, and interpersonal trust, social cohesion, personal safety at distal level) and physical environmental (neighbourhood aesthetics, neighbourhood physical activity environment, number of televisions) factors in the association between education and TV viewing time was examined using the product-of-coefficients test of MacKinnon based on multilevel linear regression analyses (conducted in 2012).

RESULTS

Multiple mediating analyses showed that BMI (p ≤ 0.01), personal safety (p < 0.001), neighbourhood aesthetics (p ≤ 0.01) and number of televisions (p ≤ 0.01) partly explained the educational inequalities in older adult's TV viewing. No proximal social factors mediated the education-TV viewing association.

CONCLUSIONS

Interventions aimed to reduce TV viewing should focus on personal (BMI) and environmental (personal safety, neighbourhood aesthetics, number of televisions) factors, in order to overcome educational inequalities in sedentary behaviour among older adults.

Sociodemographic and anthropometric factors associated with screen-based sedentary behavior among Japanese adults: a population-based cross-sectional study

BACKGROUND

Concern over the health risks of sedentary behavior has highlighted the need to examine factors associated with screen-based (television/computer) sedentary behavior. The present study examined the association of screen-based sedentary behavior with body weight and sociodemographic attributes among Japanese adults.

METHODS

A population-based cross-sectional study enrolled 1034 Japanese adults aged 40 to 69 years who lived in 2 Japanese cities. Sociodemographic variables, height, weight, and time spent on screen-based sedentary behavior were collected by self-administered questionnaire. Differences in screen time in relation to body mass index and weight gain since age 20 years were assessed by the Mann-Whitney U test. Independent associations of each variable with screen time were examined by forced-entry logistic regression analyses.

RESULTS

Mean (SD) age and median (interquartile range) duration of screen time per week were 55.6 (8.4) years and 832.0 (368.8-1263.1) minutes, respectively, for men, and 55.3 (8.4) years and 852.6 (426.0-1307.5) minutes, respectively, for women. Screen time among participants with weight gain was longer than among those with a weight gain of less than 10 kg (P = 0.08). Unmarried and unemployed participants had longer screen times. Participants aged 40 to 49 years were less likely than older age groups to spend time on screen-based sedentary behavior during leisure hours.

CONCLUSIONS

The present findings imply that strategies are necessary to discourage screen-based sedentary behavior among all demographic groups, especially among adults who are elderly, unmarried, or unemployed.

The relationship between cell phone use, physical and sedentary activity, and cardiorespiratory fitness in a sample of U.S. college students

BACKGROUND

Today's cell phones increase opportunities for activities traditionally defined as sedentary behaviors (e.g., surfing the internet, playing video games). People who participate in large amounts of sedentary behaviors, relative to those who do not, tend to be less physically active, less physically fit, and at greater risk for health problems. However, cell phone use does not have to be a sedentary behavior as these devices are portable. It can occur while standing or during mild-to-moderate intensity physical activity. Thus, the relationship between cell phone use, physical and sedentary activity, and physical fitness is unclear. The purpose of this study was to investigate these relationships among a sample of healthy college students.

METHODS

Participants were first interviewed about their physical activity behavior and cell phone use. Then body composition was assessed and the validated self-efficacy survey for exercise behaviors completed. This was followed by a progressive exercise test on a treadmill to exhaustion. Peak oxygen consumption (VO2 peak) during exercise was used to measure cardiorespiratory fitness. Hierarchical regression was used to assess the relationship between cell phone use and cardiorespiratory fitness after controlling for sex, self-efficacy, and percent body fat. Interview data was transcribed, coded, and Chi-square analysis was used to compare the responses of low and high frequency cell phone users.

RESULTS

Cell phone use was significantly (p = 0.047) and negatively (β = -0.25) related to cardio respiratory fitness independent of sex, self-efficacy, and percent fat which were also significant predictors (p < 0.05). Interview data offered several possible explanations for this relationship. First, high frequency users were more likely than low frequency users to report forgoing opportunities for physical activity in order to use their cell phones for sedentary behaviors. Second, low frequency users were more likely to report being connected to active peer groups through their cell phones and to cite this as a motivation for physical activity. Third, high levels of cell phone use indicated a broader pattern of sedentary behaviors apart from cell phone use, such as watching television.

CONCLUSION

Cell phone use, like traditional sedentary behaviors, may disrupt physical activity and reduce cardiorespiratory fitness.

TV viewing and BMI by race/ethnicity and socio-economic status

Objective

To assess the association between TV viewing and obesity by race/ethnicity and socio-economic status.

Design

Cross-sectional analysis of 5,087 respondents to the Health Information National Trends Survey (HINTS), a nationally representative sample of US adults. Multivariate regression models were computed to assess the association between quartiles of TV viewing and BMI, stratified by race/ethnicity, educational attainment, employment and health insurance status.

Results

Findings indicate that increased TV viewing was associated with higher odds for being overweight/obese in the entire sample, while adjusting for physical activity and other confounders. After stratification by race/ethnicity, increased odds for overweight/obesity in the 3^rd and 4^th quartiles of TV viewing (e.g., 3^rd quartile- cumulative OR = 1.43, 95%CI 1.07–1.92) was observed in non-Hispanic whites, with statistical significance. In non-Hispanic blacks and Hispanics, the odds were similar to whites, but did not reach statistical significance. Significant relations between greater TV viewing and increased BMI were observed in college graduates and non-graduates, those with health insurance and the employed.

Conclusions

This study extends previous research by examining potential inconsistencies in this association between various racial/ethnic groups and some socio-economic variables, which primarily were not found.

Harnessing different motivational frames via mobile phones to promote daily physical activity and reduce sedentary behavior in aging adults

Mobile devices are a promising channel for delivering just-in-time guidance and support for improving key daily health behaviors. Despite an explosion of mobile phone applications aimed at physical activity and other health behaviors, few have been based on theoretically derived constructs and empirical evidence. Eighty adults ages 45 years and older who were insufficiently physically active, engaged in prolonged daily sitting, and were new to smartphone technology, participated in iterative design development and feasibility testing of three daily activity smartphone applications based on motivational frames drawn from behavioral science theory and evidence. An “analytically” framed custom application focused on personalized goal setting, self-monitoring, and active problem solving around barriers to behavior change. A “socially” framed custom application focused on social comparisons, norms, and support. An “affectively” framed custom application focused on operant conditioning principles of reinforcement scheduling and emotional transference to an avatar, whose movements and behaviors reflected the physical activity and sedentary levels of the user. To explore the applications' initial efficacy in changing regular physical activity and leisure-time sitting, behavioral changes were assessed across eight weeks in 68 participants using the CHAMPS physical activity questionnaire and the Australian sedentary behavior questionnaire. User acceptability of and satisfaction with the applications was explored via a post-intervention user survey. The results indicated that the three applications were sufficiently robust to significantly improve regular moderate-to-vigorous intensity physical activity and decrease leisure-time sitting during the 8-week behavioral adoption period. Acceptability of the applications was confirmed in the post-intervention surveys for this sample of midlife and older adults new to smartphone technology. Preliminary data exploring sustained use of the applications across a longer time period yielded promising results. The results support further systematic investigation of the efficacy of the applications for changing these key health-promoting behaviors.

Associations of perceived neighborhood physical and social environments with physical activity and television viewing in African-American men and women

PURPOSE

Few studies have assessed how attributes of neighborhood environments contribute to sedentary, in addition to active, behaviors. This study investigated associations of perceived social and physical aspects of neighborhood environments with television (TV) viewing and physical activity (PA) in African-American adults.

DESIGN

Cross-sectional analysis of self-reported survey.

SETTING

Large mega-church in Houston, Texas.

SUBJECTS

A total of 1374 African-American men and women.

MEASURES

Outcomes included log-transformed daily TV viewing and participation in medium/high levels of PA, measured by the short version of the International Physical Activity Questionnaire. Neighborhood perceptions were assessed with the Social Cohesion and Trust and the Neighborhood Problems scales.

ANALYSIS

Multivariable models that controlled for clustering within neighborhoods.

RESULTS

Reporting more neighborhood problems was significantly associated with greater log-transformed TV viewing in women (β = .017, SE = .006, p = .003), and social cohesion was positively associated with PA in women (odds ratio = 1.06, 95% confidence interval = 1.02, 1.11, p = .006). Concerns about litter and walking after dark and a lack of places to shop were associated with increased TV viewing among women, and concerns about traffic and walking after dark were associated with reduced PA among men.

CONCLUSION

Physical and social neighborhood conditions were associated with TV viewing and PA, particularly in women. Neighborhood-based strategies to reduce sedentary behaviors and enhance PA should include attention to social as well as physical aspects of neighborhood environments.

Correlates of change in adults' television viewing time: a four-year follow-up study

PURPOSE

Adults tend to increase their television (TV) viewing time as they age, but little is known about attributes associated with change in TV viewing over time. This study examined individual, social, and environmental correlates of change in TV viewing time for 4 yr.

METHODS

Adult participants (n = 897) from a longitudinal epidemiological study in Adelaide, Australia, reported TV viewing time at baseline (2003-2004) and at follow- up (2007-2008). Generalized linear modeling was used to examine correlates of change in TV viewing time.

RESULTS

The mean TV viewing time increased from 112 to 116 min·d(-1) from baseline to follow-up. Adjusted for TV viewing time at baseline, having a tertiary education was associated with a 13% lower TV time at follow-up (P = 0.007). Each additional hour of occupational and transport physical activity at baseline was associated with a 2% and 7% lower TV viewing at follow-up (P = 0.031 and P = 0.023, respectively). For men, an additional hour of domestic physical activity was associated with a 7% higher TV viewing time at follow-up (P = 0.006). A significant neighborhood walkability × working status interaction (P = 0.035) indicated that, for those who were not working, living in a highly walkable neighborhood was associated with a 23% lower TV viewing time at follow-up (P = 0.003).

CONCLUSIONS

Adults with lower educational attainment, adults with lower occupational and transport physical activity, men with higher domestic physical activity, and nonworking adults living in lowly walkable neighborhoods were at higher risk of increase in TV viewing time. Interventions should target multiple variables at the individual, social, and environmental levels to address age-related increases in TV viewing time.

Mental health and family functioning as correlates of a sedentary lifestyle among low-income women with young children

The authors in this cross-sectional study examined mental health and family environmental factors related to a sedentary lifestyle, including lack of leisure-time physical activity and high levels of television viewing, among low-income mothers/female guardians of preschool-aged children. A self-administered questionnaire was completed by 131 mothers in 2010. Primary outcome measures included television viewing time (minutes/day) and leisure-time physical activity (<150 versus ≥150 minutes per week). Independent variables included depressive symptoms, perceived stress, and family functioning. Demographic factors (age, marriage, work status, education, number of children in the household, and race/ethnicity) were examined as potential covariates. Participating women watched television on average 186.1 minutes/day (i.e., >3 hours). Additionally, 36% of women engaged in less than the recommended 150-minute leisure-time physical activity per week. Hierarchical multiple regression analyses indicated that greater depressive symptoms (B = 76.4, p < 0.01) and lower family functioning (B = 33.0, p < 0.05) were independently related to greater television viewing when controlling for other variables. No independent factors were identified for lack of leisure-time physical activity when controlling for other covariates. Findings suggest that health promotion efforts to promote an active lifestyle among low-income women with young children should address mental health and family functioning factors, especially depressive symptoms.

Correlates of Omani adults' physical inactivity and sitting time

OBJECTIVE

To inform public health approaches for chronic disease prevention, the present study identified sociodemographic, anthropometric and behavioural correlates of work, transport and leisure physical inactivity and sitting time among adults in Oman.

DESIGN

Cross-sectional study using the WHO STEPwise study methodology.

SETTING

Sur City, Oman.

SUBJECTS

Men and women aged 20 years and older (n = 1335) in the Sur City Healthy Lifestyle Study who had complete data for demographic variables (gender, age, education, work status and marital status), BMI and behavioural risk factors – smoking and dietary habits plus physical inactivity and sitting time (the outcome variables).

RESULTS

The highest level of physical inactivity was in the leisure domain (55.4 %); median sitting time was about 2 h/d. Gender-stratified logistic regression models found that the statistically significant (P < 0.05) correlates of inactivity (in one or more domains) were age, work status and fruit and vegetable intake in women, and age, education, work status, marital status and BMI in men. Gender-stratified linear regression models found that the statistically significant correlates of sitting time were age, work status and BMI in women and education in men.

CONCLUSIONS

Findings suggest that public health interventions need to be gender responsive and focus on domain-specific physical inactivity. In the Omani context, this might include gender-segregated exercise facilities to promote leisure physical activity among women and walking-friendly environmental initiatives to promote transport physical activity among men. Further evidence on barriers to physical activity and factors that influence prolonged sitting is required to develop relevant public health interventions.

Mid-aged adults' sitting time in three contexts

BACKGROUND

To develop evidence-based approaches for reducing sedentary behavior, there is a need to identify the specific settings where prolonged sitting occurs, associated factors, and variations.

PURPOSE

To examine the sociodemographic and health factors associated with mid-aged adults' sitting time in three contexts and variations between weekdays and weekend days.

METHODS

A mail survey was sent to 17,000 adults (aged 40-65 years) in 2007; 11,037 responses were received (68.5%); and 7719 were analyzed in 2010. Respondents indicated time spent sitting on a usual weekday and weekend day for watching TV, general leisure, and home computer use. Multivariate linear mixed models with area-level random intercepts were used to examine (1) associations between sociodemographic and health variables and sitting time, and (2) interaction effects of weekday/weekend day with each of gender, age, education, and employment status, on sitting time.

RESULTS

For each context, longer sitting times were reported by those single and living alone, and those whose health restricted activity. For watching TV, longer sitting times were reported by men; smokers; and those with high school or lower education, not in paid employment, in poor health, and with BMI ≥25. For general leisure, longer sitting times were reported by women, smokers, and those not employed full-time. For home computer use, longer sitting times were reported by men; and those aged 40-44 years, with university qualifications; in the mid-income range; and with BMI ≥30. Sitting times tended to be longer on weekend days than weekdays, although the extent of this differed among sociodemographic groups.

CONCLUSIONS

Sociodemographic and health factors associated with sitting time differ by context and between weekdays and weekend days.

Appetite regulation in response to sitting and energy imbalance

The impact of sitting and energy imbalance on appetite and appetite-regulating hormones (acylated ghrelin and leptin) was assessed in response to 1 day of sitting, with and without changes in energy intake. Fourteen men and women completed each of three 24-h conditions: high energy expenditure (standing) with energy balance (STAND), low energy expenditure (sitting) with energy surplus (SIT), and sitting with energy balance (SIT-BAL). Ghrelin, leptin, and appetite were measured in the fasted state and following a standardized meal. In the fasted state, there were no differences among conditions. Following the meal, ghrelin was lower in SIT than in STAND, with no change in appetite. When intake was reduced (SIT-BAL), the decrease in ghrelin when sitting was attenuated, hunger increased, and fullness decreased. SIT led to lower ghrelin concentrations in the men, whereas in the women, leptin increased. SIT-BAL led to an increase in ghrelin in the men but attenuated the leptin response, reduced ghrelin, increased hunger, and decreased fullness in the women. Because a dramatic reduction in energy expenditure was not accompanied by reduced appetite, prolonged sitting may promote excess energy intake, leading to weight gain in both men and women.

Adult sedentary behavior: a systematic review

CONTEXT

While the health benefits of meeting moderate/vigorous-intensity physical activity (MVPA) guidelines have been well established, the health risks of sedentary behavior, independent of meeting MVPA guidelines, are becoming evident. Sedentary behavior may require different interventions, based on correlates that differ from MVPA. The current review aimed to collect and appraise the current literature on correlates of sedentary behaviors among adults.

EVIDENCE ACQUISITION

Papers were considered eligible if they were published in English-language peer-reviewed journals and examined correlates of sedentary behaviors. Literature searches were conducted in August 2011 among ten search engines yielding 3691 potentially relevant records; of these, 109 papers (82 independent samples) passed eligibility criteria.

EVIDENCE SYNTHESIS

Articles included were published between 1982 and 2011, with sample sizes ranging from 39 to 123,216. Eighty-three were cross-sectional, 24 followed a prospective design, one was experimental baseline data, and one was cohort design. Sedentary behavior was primarily measured as TV viewing or computer use, followed by analysis of a more omnibus assessment of time spent sitting. Evidence was present for sedentary behavior and correlates of education, age, employment status, gender, BMI, income, smoking status, MVPA, attitudes, and depressive symptoms/quality of life. Notable differences by specific sedentary behaviors were present that aided in the explanation of findings.

CONCLUSIONS

Results point to the high specificity of various sedentary behaviors (e.g., TV viewing vs sitting and socializing), suggesting that the research domain is complex and cannot be considered the simple absence of MVPA. Several sociodemographic and health factors appear reliably linked to sedentary behavior, yet there is an obvious absence of research focused on cognitive, social, and environmental factors that could be of use in anti-sedentary behavior interventions.

Cross-sectional associations between occupational and leisure-time sitting, physical activity and obesity in working adults

AIM

To examine associations between occupational and leisure-time sitting, physical activity and obesity in working adults.

METHODS

We analyzed data from workers from the 2007-08 Australian National Health Survey (n=10,785). Participants reported their activity at work (mostly sitting, standing, walking, or heavy labor), transport-related walking, leisure-time sitting and physical activity. Body mass index was objectively measured. Adjusted Cox proportional hazard regression models examined associations between occupational activity category, leisure-time sitting, physical activity and obesity risk.

RESULTS

Substantial proportions of men (42%) and women (47%) mostly sit at work. Workers with sitting jobs were significantly more likely to be sufficiently active during leisure-time than workers with mostly standing, walking or heavy labor jobs (RR=0.88, 0.80, 0.86 respectively). Workers with mostly sitting jobs had significantly higher overweight/obesity risk than workers with mostly standing jobs (RR=0.88, 95% CI: 0.82-0.95) independent of physical activity and leisure-time sitting. Workers with leisure-time sitting of less than four hours per day had significantly lower obesity risk than workers with four or more hours per day of leisure-time sitting (RR=0.77, 95%CI: 0.69-0.87) independent of physical activity and occupational activity.

CONCLUSIONS

Sitting time and physical activity are independently associated with obesity. Leisure-time sitting may have a stronger association with obesity risk than occupational sitting.

Associations between perceived neighborhood environmental attributes and adults' sedentary behavior: findings from the U.S.A., Australia and Belgium

Sedentary behaviors are associated with multiple health problems, independently of physical activity. Neighborhood environment attributes might influence sedentary behaviors, but few studies have investigated these relationships. Moreover, all previous studies have been conducted within single countries, limiting environmental variability. We investigated the shape of associations between perceived neighborhood environment attributes and sedentary behavior in three countries; and whether these associations differed by country and gender. Data from U.S.A. (Seattle and Baltimore regions), Australia (Adelaide) and Belgium (Ghent) were pooled. Data collection took place between 2002 and 2008. In total, 6014 adults (20-65 years, 55.7% women) were recruited in high-/low-walkability and high-/low-income neighborhoods. All participants completed the International Physical Activity Questionnaire (domain-specific physical activity, transport-related sitting and overall time spent sitting) and the Neighborhood Environmental Walkability Scale (environmental perceptions). The number of destinations within a 20 min walk from home, perceiving few cul-de-sacs, good walking and cycling facilities, and traffic safety were included in an index of motorized transport correlates. This index was linearly negatively associated with motorized transport time, so the higher the scores on the index (more activity-friendliness), the lower the amount of motorized transport. No gender- or country-differences were identified. Perceived aesthetics and proximity of destinations were included in an index of overall sitting time correlates. A linear negative relationship with overall sitting time was found, but associations were stronger for men and not significant in Belgian adults. In conclusion, consistent and expected correlates were found for motorized transport in the three countries, but results were less clear for overall sitting time. Future studies should include even more countries to maximize environmental variability, but present findings suggest that neighborhoods may be designed to improve health through supporting more active and less sedentary transportation, which can be expected to have health benefits.

Socio-demographic, psychosocial and home-environmental attributes associated with adults' domestic screen time

BACKGROUND

Sedentary behaviors (involving prolonged sitting time) are associated with deleterious health consequences, independent of (lack of) physical activity. To inform interventions, correlates of prevalent sedentary behaviors need to be identified. We examined associations of socio-demographic, home-environmental and psychosocial factors with adults' TV viewing time and leisure-time Internet use; and whether psychosocial and environmental correlates differed according to gender, age and educational attainment.

METHODS

This cross-sectional study was conducted in Ghent, Belgium, between March and May 2010. Respondents to a mail-out survey (n = 419; 20-65 years; mean age 48.5 [12.1] years; 47.3% men) completed a questionnaire on sedentary behaviors and their potential socio-demographic, psychosocial and home environmental correlates. Statistical analyses were performed using multiple linear regression models.

RESULTS

The independent variables explained 31% of the variance in TV viewing time and 38% of the variance in leisure-time Internet use. Higher education, greater perceived pros of and confidence about reducing TV time were negatively associated with TV viewing time; older age, higher body mass index, larger TV set size and greater perceived cons of reducing TV time showed positive associations. Perceived pros of and confidence about reducing Internet use were negatively associated with leisure-time Internet use; higher education, number of computers in the home, positive family social norms about Internet use and perceived cons of reducing Internet use showed positive associations. None of the socio-demographic factors moderated these associations.

CONCLUSIONS

Educational level, age, self-efficacy and pros/cons were the most important correlates identified in this study. If further cross-sectional and longitudinal research can confirm these findings, tailored interventions focusing on both psychosocial and environmental factors in specific population subgroups might be most effective to reduce domestic screen time.

Adults' sedentary behavior determinants and interventions

Research is now required on factors influencing adults' sedentary behaviors, and effective approaches to behavioral-change intervention must be identified. The strategies for influencing sedentary behavior will need to be informed by evidence on the most important modifiable behavioral determinants. However, much of the available evidence relevant to understanding the determinants of sedentary behaviors is from cross-sectional studies, which are limited in that they identify only behavioral "correlates." As is the case for physical activity, a behavior- and context-specific approach is needed to understand the multiple determinants operating in the different settings within which these behaviors are most prevalent. To this end, an ecologic model of sedentary behaviors is described, highlighting the behavior settings construct. The behaviors and contexts of primary concern are TV viewing and other screen-focused behaviors in domestic environments, prolonged sitting in the workplace, and time spent sitting in automobiles. Research is needed to clarify the multiple levels of determinants of prolonged sitting time, which are likely to operate in distinct ways in these different contexts. Controlled trials on the feasibility and efficacy of interventions to reduce and break up sedentary behaviors among adults in domestic, workplace, and transportation environments are particularly required. It would be informative for the field to have evidence on the outcomes of "natural experiments," such as the introduction of nonseated working options in occupational environments or new transportation infrastructure in communities.

Physical activity and sedentary behaviours among rural adults in Suixi, China: a cross-sectional study

Background

Modernisation and urbanisation have led to lifestyle changes and increasing risks for chronic diseases in China. Physical activity and sedentary behaviours among rural populations need to be better understood, as the rural areas are undergoing rapid transitions. This study assessed levels of physical activity and sedentary behaviours of farming and non-farming adults in rural Suixi, described activity differences between farming and non-farming seasons, and examined correlates of leisure-time physical activity (LTPA) and TV viewing.

Methods

A random sample of rural adults (n = 287) in Suixi County, Guangdong, China were surveyed in 2009 by trained interviewers. Questionnaires assessed multiple physical activities and sedentary behaviours, and their correlates. Analysis of covariance compared activity patterns across occupations, and multiple logistic regressions assessed correlates of LTPA and TV viewing. Quantitative data analyses were followed by community consultation for validation and interpretation of findings.

Results

Activity patterns differed by occupation. Farmers were more active through their work than other occupations, but were less active and more sedentary during the non-farming season than the farming season. Rural adults in Suixi generally had a low level of LTPA and a high level of TV viewing. Marital status, household size, social modelling for LTPA and owning sports equipment were significantly associated with LTPA but not with TV time. Most findings were validated through community consultation.

Conclusions

For chronic disease prevention, attention should be paid to the currently decreasing occupational physical activity and increasing sedentary behaviours in rural China. Community and socially-based initiatives provide opportunities to promote LTPA and prevent further increase in sedentary behaviours.

Quitline Utilization Rates of African-American and White Smokers: The California Experience

Purpose.

To compare the utilization rate of a statewide tobacco quitline by African-American smokers to that of white smokers.

Design, Setting, and Subjects.

Observational study of 18 years of state quitline operation in California. Subjects were 61,096 African-American and 279,042 white smokers who called the quitline from August 1992 to December 2009. Data from six California Tobacco Surveys, 1993, 1996, 1999, 2002, 2005, and 2008 were also used.

Measure.

Callers' answers to the question how they heard about the quitline were grouped into four categories: media, health care providers, friends/family, and others.

Analysis.

The averaged annual quitline call volume for each ethnic group was divided by the total number of smokers in that group, based on California Tobacco Surveys, to produce the annual quitline utilization rate.

Results.

In five out of six periods of comparison, African-American smokers had a higher annual utilization rate than white smokers. The odds ratios [ORs] ranged from 1.44 to 2.40 (all p < .05). In the 1996 comparison, the OR was .90 (p < .05). The difference in utilization rates that is attributed to media, accounts for most of the difference in total utilization rates between the two ethnic groups.

Conclusions.

Within the context of California's comprehensive tobacco control program, which includes a strong media campaign, African-American smokers were significantly more likely to call the state quitline than white smokers were. Promoting the quitline as part of antismoking media campaigns can help reduce disparity in cessation service utilization. (Am J Health Promot 2011;25[5 Supplement]:S51–S58.)

Physiological and health implications of a sedentary lifestyle

Sedentary behaviour is associated with deleterious health outcomes, which differ from those that can be attributed to a lack of moderate to vigorous physical activity. This has led to the field of "sedentary physiology", which may be considered as separate and distinct from exercise physiology. This paper gives an overview of this emerging area of research and highlights the ways that it differs from traditional exercise physiology. Definitions of key terms associated with the field of sedentary physiology and a review of the self-report and objective methods for assessing sedentary behaviour are provided. Proposed mechanisms of sedentary physiology are examined, and how they differ from those linking physical activity and health are highlighted. Evidence relating to associations of sedentary behaviours with major health outcomes and the population prevalence and correlates of sedentary behaviours are reviewed. Recommendations for future research are proposed.